Heart attacks start with a percolating cold sweat. Nausea ripples through your body. Your chest tightens and you can hardly breathe. Rationality and thought leave you when crippling pain in your stomach sends you helplessly to the floor as you struggle to stay conscious.
Paramedics burst through your door and whisk you into an ambulance. They quickly administer an electrocardiogram (EKG) to monitor your heart. But when they get you to the hospital, the team isn’t ready to save you. The cardiologist hasn’t studied the EKG yet. In fact, he isn’t even in the hospital. He’s still en route.
Thankfully, we’re moving past such inefficient ways—the life-saving technology of sending data to the cardiologist ahead of time is not only here, it’s winning awards.
On May 17, the Society of Cardiovascular Angiography and Interventions (SCAI) honored the University of Medicine and Dentistry of New Jersey (UMDNJ) for presenting the best abstract for enhancing the quality of patient care in 2006. Proposed by Chief of Cardiology Marc Klapholz and Chief Academic Fellow of Cardiology Vivek Dhruva, UMDNJ’s breakthrough is a network of Bluetooth transfers from the ambulance to cardiologists’ smart phones and the ER.
“The name of the game is to open up the artery as soon as possible,” says Dhruva. UMDNJ’s paramedics use Medtronic’s Lifepak 12 and Lifenet Blue technology (see the figure). These niche devices take EKGs, relay the information wirelessly using Bluetooth technology, and perform emergency defibrillation when necessary.
The paramedics send a wireless transmission to the hospital’s ER, where a Medtronic server analyzes the data. In dire circumstances, the server relays the message to the catheterization lab, where another server creates a PDF and disburses it to all cardiologists on staff.
Every cardiologist carries an Audiovox 6700 smart phone equipped with Adobe software to view the data. The readout, which is a PDF of the diagnostic taken in the ambulance, provides the information needed to determine if a patient needs an emergency intervention. And since last June, UMDNJ’s wireless transceiver technology has paved the way for vast improvements.
According to Dhruva, UMDNJ was at least in the bottom 20% of “door-to-intervention time” nationally in 2005, taking an average of 145 minutes to open the infarct-related coronary artery. “Achieving the golden hour was unheard of and hard to do,” says Dhruva. “We have done it during the daytime. Overall, we’ve drastically cut down times and our door-to-intervention time is down to 73 minutes currently.”
The golden hour represents time that is very crucial to a patient’s outcome. According to the American Heart Association, brain damage can occur in as few as four to six minutes after the heart stops pumping blood. Without immediate CPR or defibrillation, the survival rate plummets by 7% to 10% every minute until aid is provided.
While these moments used to be wasted chasing down doctors, they are now used to save lives. Two years later, the institution sits in the top 10% to 20% of intervention times.
Although this system pulled UMDNJ out of troubled waters, it is not without flaws. In some rural and urban areas, there are dead zones for wireless reception. Also, paramedics are charged with determining whether or not the EKG taken in the ambulance is a true heart attack and worth transmit- ting to the cardiologist.
“We think the ‘false-positives’ are well worth the trouble because we don’t want to miss one,” says Dhruva. Also, according to Dhruva, UMDNJ computers infected by viruses malfunctioned in the past when receiving or relaying the transmission. But measures have been taken to sidestep fouled messaging since then.
Medtronic created Lifenet technologies in 2003. Although the company originally developed the system utilizing portable PCs and data-collecting software, UMDNJ was the first to utilize Bluetooth transmissions in smart phones and show a significant decrease in door-to-intervention time.
American Heart Association
www.americanheart.org
Medtronic
www.medtronic.com